Financial hardship screening in Native American patients with cancer: Results from a quality improvement program at an NCI-designated cancer center.

434 Background: Many Native American (NA) patients with cancer are at risk of substantial financial hardship related to their illness. However, financial hardship screening (FHS) has rarely been implemented in this population. Funded by a grant from the American Cancer Society to enhance navigation services, we instituted FHS for NA patients in the NA Navigation (NAN) program at the Stephenson Cancer Center (SCC) in Oklahoma City. Methods: SCC’s NAN program coordinates oncology referrals for adult patients from Indian Health Service, Tribal Health, or Urban Indian Health (I/T/U) programs across the state of Oklahoma. NAN patients with cancer who were seen at SCC between July 1, 2023, and February 28, 2025, received FHS using the Comprehensive Score for Financial Toxicity (COST) tool. Patients first answered the single question, “My illness has been a financial hardship to my family and me.” Patients who responded “Not at all” or “a little bit” did not receive further screening. Patients who reported “Somewhat,” “Quite a bit,” or “Very much,” were asked to complete the remaining 11-item COST survey. COST scores (0–44) were grouped into: no/mild (≥26), moderate (14–25), or severe (0–13) financial hardship. Descriptive statistics and item-level response patterns were analyzed. Results: Among 129 patients screened, 33 (25.6%) completed the full COST tool after indicating more than a little financial hardship from the initial screening question. Of these, the mean COST score was 14.97 ± 8.08; median 13.00 (IQR: 9.00–19.50), indicating severe financial distress. Most of these patients (88%) reported “not at all” to having enough money in savings or assets to cover treatment. Approximately three-quarters of respondents (72%) were highly concerned about future financial problems. Over half of respondents felt they had no choice over how much to spend on their cancer care (66%) and were very frustrated by their inability to work or contribute financially (56%). Nearly half of participants reported not feeling in control of their financial situation (47%) and only one-third (34%) reported being able to meet monthly expenses. By reporting period, screening positivity rose from 22.9% (Jul–Dec 2023) to 41.2% (Jul–Dec 2024). Conclusions: One-quarter of the screened I/T/U patients with cancer experience significant financial hardship associated with their illness, with scores suggesting severe hardship. Lack of savings, employment strain, and high stress were often reported. The COST tool was acceptable and useful in identifying unmet needs. These findings support expanding structured, culturally competent FHS and financial navigation within NAN programs.